293623327-12-2-2019-03-CC-ABLI-BJGRTY-20191202121907

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 293623327
Report Date: 12/02/2019
Date Signed: 12/02/2019 12:19:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	GRANHOLM, KATHLEEN & GRANHOLM, DANNY		FACILITY NUMBER:	293623327
ADMINISTRATOR:	GRANHOLM, KATHLEEN & GRANH		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(530) 362-2846
CITY:	GRASS VALLEY	STATE: CA	ZIP CODE:	95945
CAPACITY:	14	CENSUS: 0	DATE:	12/02/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kathleen and Danny Granholm		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPAs) Amanda Blesi and Jeremey McClain met with applicant for a pre licensing inspection. Also present today was licensee’s spouse Danny. LPAs toured the 3 bedroom, 2 bathroom one story home inside and out. LPA reviewed forms for children's records. Applicant owns the home and LPA received a copy of mortgage statement for control of property. LPA explained about obtaining $300,000 liability insurance. Applicant understands that until a policy is obtained, an affidavit must be used. Applicant has certificates of completion for 8 hours of health and safety training and is currently enrolled to take the preventative health class on 1/18/2020. All adult residents received criminal record clearances and proof of TB clearance. LPA reminded applicant of the applicable Civil Penalty per person for those adults, including your own child, who have not received fingerprint clearances, are not associated to the license, come in contact with and or provide care and supervision to the children. LPA provided the Community Care Licensing website www.ccld.ca.gov, to obtain updated licensing information, new regulations and access forms. LPA advised the applicant of their responsibility to stay current regarding new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov. Applicant understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. Off-limit areas include: backyard deck. Applicant understands that children may never enter these off-limit areas. LPA reviewed the fire drill requirements. The two wood burning stoves are barricaded. LPAs observed weapons to be stored and locked separately from ammunition. LPA observed a 2A10BC fire extinguisher. LPA observed a working carbon monoxide detector and smoke detector was tested and observed to be working. Hazardous cleaning compounds are inaccessible to children. Sharp utensils and Medications are inaccessible to children. The backyard is fenced and there is a pond on the property. The pond is surrounded by a wire animal fencing and was measured to be 5 feet high. There are no windows or doors leading into the pond area. There are three access gates one of the gates was observed to self close and self latch. Applicant understands that the two gates that do not self close and self latch must remained locked while children are in care. Applicant understands that in any unfenced areas, 100% supervision of children is required. Continued on the following page LIC 809-C

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GRANHOLM, KATHLEEN & GRANHOLM, DANNY	FACILITY NUMBER: 293623327
	VISIT DATE: 12/02/2019

NARRATIVE

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IMS- (not providing)
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Mandated Reporter Training (AB1207) The licensee and staff must complete the training every two years starting January 1, 2018 and retain proof of completion in the facility file. The training can be taken online at: mandatedreporterca.com. LPA observed applicant has completed the training.

CONDITIONS REQUIRING CORRECTION PRIOR TO ISSUING A LICENSE:

1. The current fencing for the pond must be approved by management. (a waiver may be required).

Upon final approval from management a license will be issued to serve 14 children with an assistant present.

SUPERVISOR'S NAME: Keven Peters	TELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda Blesi	TELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019

LIC809 (FAS) - (06/04)

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